Unlatched, a breastfeeding advocacy, community Facebook page recently shared its #NipplesInNature project where followers can enjoy and share breast-like images found in the natural world. (See more at: https://twitter.com/the_unlatched/media/grid) Breasts are everywhere! For someone who has birth, breastfeeding and babies always on her mind, it’s reassuring to know that others have mammary hallucinations as well.
Healthy Children Project will host its 18th Annual International Breastfeeding Conference in Orlando, Fla. January 13 to 17, 2014. The conference offers those obsessed with birth and breastfeeding like myself, and those simply looking to learn more about maternal infant health, an opportunity to network with and learn from a diverse group of outstanding health care professionals.
This year, participants will engage with the inspirational Dr. Soo Downe, PhD, BA, MSc, OBE who spent 15 years working as a midwife in various clinical, research, and project development roles, after which, in January 2001 she joined the University of Central Lancashire (UCLAN) in England, where she serves as Professor of Midwifery Studies.
Downe’s main research focus is the nature of, and cultures around, normal birth. She is the editor of Normal Birth, Evidence and Debate (2004, 2008), and the founder of the International Normal Birth Research conference series. She is currently the principal investigator on the SHIP trial of the use of self-hypnosis in labor (funded by the NHS RfPB) and an EU COST Action on childbirth contexts, cultures and consequences. [Retrieved from: http://www.healthychildren.cc/PDFs/2014%20International%20Conference%20Flyer.pdf]
Downe’s conference presentations this year include “Physiological labor and birth: why does it matter, and how can we make it happen?” and “First, do no harm: Emerging evidence on the long-term consequences of what happens during childbirth”.
Dr. Downe was kind enough to share with us her ingenious thoughts on birth and breastfeeding. It will be fascinating and such a pleasure to attend her presentations at the upcoming conference.
How did you become interested in maternal fetal/infant health?
The first time I saw a baby being born was when I was spending some time on a maternity station in Bophuthatswana in South Africa in the late 1970s. The midwives who run the small maternity ward in the middle of the apparently, absolutely nowhere were remarkably calm and confident, caring and skilled. The women who came to give birth were equally remarkable: strong, sure, with apparently no doubts about the capacity to give birth, despite the fact that some of the babies did not survive during my very short stay of a few weeks. It seemed to me at that time that the process of giving birth was a remarkable one and if we could get this right, we could probably get the world right. I still think this now.
What fascinates you most about birth?
What has always fascinated me is the sense that this process is far more than just getting a baby out. It is something that links us back through all our ancestors, and into the future, and we are all (mother, father, baby) irrevocably marked by it. It is also one of the few experiences left in society which, when undertaken physiologically, is ultimately unpredictable and uncontrollable and, as a consequence, deeply emotional. It takes all those who experience it authentically to the very edge of their capacity to cope, and it says to them, you can do this – and if you can do this, you can do anything. Getting it right is therefore profoundly important for the wellbeing of families, and for future generations. While I have always believed this intuitively, recent exciting evidence from epigenetics seems to suggest that there is biological evidence for the impact of labour and birth on way genes might be expressed for the child, and for their adulthood, and then their own children in the future.
Is there one outstanding challenge women are up against when it comes to normal childbirth? Is it the West’s fragmented health care systems, our society’s propensity to control women’s bodies, our litigation culture, our deviation from nature and reliance on technology? Something else?
All of the above! But fundamentally, we are fighting against a lack of faith from women and sadly, from their primary caregivers (midwives and doctors) in the capacity of women to give birth physiologically, in the benefits of undergoing this process for mother, baby, father/partner and family, and in the long-term, subtle, vital interplay between the way a baby is born and its capacity to remain well /resist ill health in the future.
Why should people care if women aren’t birthing the way they chose and/or going through traumatic birth experiences? What effect does this have on the future of our society?
For the reasons I’ve alluded to above. Given that every single person who has ever lived on earth went through the process of being born, it must matter to all of us how birth happens, and what the consequences might be. We have known for a long time that some women who experience a traumatic birth (whether this is a Caesarean or a so-called ‘normal birth’) can go on to suffer from depression, or even overt post-traumatic stress syndrome. We also know that these kinds of negative effects can have an impact on the way infants are parented, and on their long-term capacity to thrive in some cases.
Now, with a new evidence coming from the epigenetic field, and from other epidemiological data, it looks like there may be links between the way babies are born and what happens during labour and birth, and a whole range of long-term diseases, such as type I diabetes, multiple sclerosis, asthma, eczema, even some cancers. There are also associations between interventions that happened during labour and birth and a later risk of obesity and ADHD. Some studies, though not all, show that interventions such as the use a Caesarean section and epidurals might be linked with some of these outcomes. Even if future focused research finds that these associations do in fact exist, we don’t really know what the causative factors are. For example, women who have the Caesarean sections are more likely to have antibiotics intrapartum, so the effect may be to do with antibiotic overuse, which is another issue that is of great concern for WHO at the moment. Antibiotic overuse in labouring women and in neonates is a factor in the increasing risk of antibiotic resistance internationally. Clearly this has very important implications for the treatment of infection in the future across all population groups, and not just in women of childbearing age and their babies.
Please comment on the importance of evidence-based research as it relates to advancing maternal infant health care.
To paraphrase David Sackett, evidence-based medicine is a combination of best evidence (which could be qualitative or quantitative or anything in between); clinical skills; and service user values. So in answering this question I bear in mind all these three aspects of what evidence is. It’s really important to understand what it is about labour and birth that makes a difference, what the limits of physiology are, when it’s necessary to intervene, and when it’s important to let go. We need to know how women and their partners and their families feel about this process, how midwives, doulas doctors and other caregivers feel about the kind of care they are giving, how this care is organised to best effect, and then, at the basic cellular and biological level, how what we do has an effect in the longer term on the well-being and the life chances of mothers babies and partners and families and societies.
So that’s why research is important: if we don’t bring together the knowledge that exists out there, bearing in mind that this knowledge is always mediated by the context of individual women and babies, partners, families, caregivers and societal cultures, then we will never advance understanding beyond the immediate experience that we have as practitioners, or as childbearing women or parents day-to-day.
What is the most challenging part of your job? The most rewarding?
Trying to get everything done is a nightmare! Dealing with the hundreds of emails that come every day, finding time to write all the bids that need to be written to get funding to do the research that are so important to do (and being turned down for funding nine times out of ten after all the hard work of writing the bid), and trying to deal with the bureaucracy and the systems of governance that seem to be proliferating in research as much as in healthcare.
The most rewarding is when childbearing women, their families, and other stakeholders tell us that the kinds of questions we are asking are those that really matter to them, and particularly when the findings of our research demonstrate that the assumptions that we are making about the importance of physiological labour and birth are borne out. Of course this always happens. Part of the point of research is to find out where we are wrong as well as when we are right; but, even when we find answers we don’t expect, there are often extremely rich insights to take forward from those unexpected findings, into future research and practice.
What one piece of advice do you have for aspiring birth and lactation care providers?
Keep the faith! The tide is turning, as research becomes more person-centred and as researchers pay more attention to complex and longer-term effects of various circumstances and treatments, and as women become more aware of and vocal about what is happening to birth and breastfeeding around the world. Complexity theory holds that once the ‘initial conditions’ have changed, systems can tip very rapidly from one place to another place. Events like this conference are part of changing these ‘initial conditions’. The increase in home births in the US is an example of the edge of the tipping point, in my view – so although it might seem that all the talking and agitating isn’t making any progress, if you keep the faith, suddenly it will!
Are you optimistic about the future of maternal infant health?
Yes I am optimistic. This is partly because of the new research that is emerging, that to be providing very strong empirical proof about the kinds of things that we’ve been talking about for a long time. It’s also because this seems to be a stronger movement globally, not just in resource rich countries. Even in resource poor countries where maternal mortality and infant mortality are very high, there is an increasing recognition that the consequent extremely high Caesarean section rates that are being used as a solution are not an appropriate answer in many cases. It may even be that some of the changes that bring childbirth and infant feeding back into a more physiological space will happen from those countries in the first instance. For example, the humanising birth movement is extremely strong in South America, and we can, and indeed we are, learning from changes that are taking place at the policy level in these countries.
What are you most looking forward to at the International Breastfeeding Conference?
Meeting with people from across the US and beyond, and considering how this new evidence might link with the known evidence on the protective effect of breastfeeding for a range of outcomes for mothers and babies.
Learn more about Downe’s work here.
To learn more about and register for the 18th Annual International Breastfeeding Conference, please click here.
Stay tuned for more Our Milky Way “Presenter Sneak Peeks”!